We need bold commissioners for challenging times

30 March 2015

Healthcare commissioning has undergone relentless change. Despite this, can we confidently say that healthcare commissioning is where we want or need it to be? I think the resounding answer would be “no”. It is becoming increasingly clear that we need to stop tinkering with the mechanics of commissioning and change the focus to the leadership and commissioners themselves.

Since 1990, we have seen ten changes to the organisational form and structure of NHS commissioning. People have been impatient to see success, but with major changes every three to four years, this has not given health professionals enough time to fully embrace initiatives or make a step change improvement in local population health.

Equally, commissioners seldom hold their posts long enough to build the relationships across the health and care system that are vital for long term transformation.

This is part of a wider problem that few people know who their local commissioner is, or what they are supposed to do. Why should they? Unlike hospitals, commissioners seldom make the news, unless they’re closing a service, which usually makes for some negative publicity.

But they do need to be in the spotlight. Commissioners spend £80 billion of tax payers’ money a year, so it is only right that communities know where their money is going, just in the same way that they receive a cost breakdown of council spending or how their income tax is spent.

They need to do more to help themselves. Clinical commissioning groups (CCGs) do not always encourage an open door culture. Unlike town halls or hospitals, they do not tend to be physically connected to the local communities they are serving. Frequently, CCGs are situated in business parks or anonymous buildings. This is a mistake for organisations that need to connect with the local population.

If commissioners do not have a relationship with the local population, they are unlikely to be able to stand up and fight for the public’s needs. Some are doing this, such as the award-winning Tower Hamlets CCG, which commissions care for one of London’s poorest boroughs,1 but for many areas of the country they remain too distant.

I know from my regular contact with CCGs that greater connection into local communities is a high priority. This will be vital to underpin the large scale service changes that are on the health horizon.

The increase of commissioners with a clinical background is certainly a step towards bridging the gap between CCGs and local communities. Their day-to-day contact with the local population gives them a far more holistic understanding of what is required for patients or service users, not only in terms of health but also social and other support services.

This is an understanding that previous commissioners with a managerial background have often struggled to achieve.

I know from my work across many parts of the NHS that this clear commissioning leadership will be welcomed. NHS England’s Five Year Forward View encourages new models of care, such as multispecialty community providers, to meet local needs. Commissioners will play a vital role in being the catalyst for this. Bold commissioners will set out health outcomes that stimulate the local health and care system to work differently to deliver them.

Commissioners can lead the way by linking outcomes and incentives to encourage innovative risk share agreements that take away some of the “win lose” debates that can paralyse a health system. Full engagement with the public will be a vital element of the outcome development. As healthcare needs become increasingly more complex, the need for bold commissioners to seize the moment is greater than ever. The challenges facing health and care services are profound. With a period of organisational stability and leadership support, I am confident that commissioners can meet these challenges.

Gary Belfield, Associate Partner and Head of Commissioning, KPMG’s Global Health Practice

1 Lind, S. (2015), “Tower Hamlets GP and CCG lead knighted in New Year’s Honours”, Pulse, 25 January

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